Provider First Line Business Practice Location Address:
10509 SAN DIEGO MISSION RD STE P
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-500-7088
Provider Business Practice Location Address Fax Number:
619-314-4252
Provider Enumeration Date:
12/09/2013